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ZONING PERMIT APPLICATION www.countyofdane.com SUPPLEMENT to Web-App # <br /> PROPERTY OWNER INFORMATION CUSTOMER TO PROVIDE <br /> OWNER NAME i ^ / <br /> L_a(C) CC`Ctih irld Zoning Status;CUP; ' x <br /> OWNER ADDRESS (((Number,Street,City,State,Zip) Deed Restriction;CSM <br /> 405 gw I� (uQutno, �,Pe 61 53541- Variance(# ) <br /> H,•,�1 PHONE ELL-HONE E-MAILADDRESS I <br /> t�D q—f{9V14 i Mc i CI C I A I v. a Mad .c4 ,°,1 Site Plan drawn to scale <br /> AGENT INFORMATION I CONTRACTOR INFORMATION and includes dimensions / O <br /> AGENT NAME CONTRACTOR NAME <br /> Vevk%" \AC CA Kevl■� MZ-Ca(Al AdSite ' - • ding location <br /> AGENT ADDRESS CONTRACTOR AD ESS Of <br /> 6t0(A (x eu.ati 6tcleev\ ((0L` Ga4e .ay 6'f epv\ <br /> (citv,stete,dip) (City Stige,Zip) gi Setbacks l,7 ' Z/ <br /> PONE HONE CCc� ;l Site Plan approval from / At- <br /> E-MAIL A <br /> (60 5) 34-15" -8q82_ 60E)3111i- c8 9 SZ applicable township. <br /> ADDRESS i g `- MAILADDRESS ` . <br /> 4 b v,, 1 Aer. e...� 4-vosaik,am kk■Mb l kUf a% K-Ct4A gFloor plans to scale <br /> PROPERTY/LOCATION INFORMATION (http://accessdane.co.dane.wi.us/) ni <br /> PARENT P - L UMBER: CURRENT ZONING ACREAGE: �` levation of property <br /> ❑PARCEL j' r/DZ Y5413 . . ' 2 / Z frontage drawn to scale. <br /> NUMBER i ' p <br /> TOWNSHIP: n SECTION: ' , /IA/ , , ,JI N ,/ (( ay permits <br /> SQr1V l�°_ ! Q /4: /V �a�a' �t/ (/(/ �J,�MI►7!county,town) <br /> ADDRESS: ff (��' <br /> -oF ""'"7tq kAt.,inQIGCe_ ( :- S 35-qq-- Sanitary permits <br /> CSM: 2 r , LOT > SUBDIVISION BLOCK/LOT (public, Vat <br /> PROPOSED PROJECT INFORMATION STAFF REVIEW <br /> PROJECT DESCRIPTION: 3 / t / L/ <br /> �A�� V ec — X / ( �— Zoning District A ._..� <br /> . ❑This project is a new building or structure. G(' �/�— A Gf L 74o gPermitted U ? 6.c,CA <br /> This project is an addition/alteration to an existing building or structure. S r� ,�A- <br /> SANITARY SERVICE: PERMIT NUMBER: i'RUral • .: - <br /> 1,4EWER rEPTIC (ne /-xisting) <br /> HEIGHT IN FEET: NUMBER OF STORIES: (Not including basement) <br /> 1 loodplain/ - <br /> AREA TO NEAREST SQUARE FOOT: tt relan (attachment) <br /> (Outside dimensions including unfinished area,attached garages and above grade decks or porches)/ ErosionControl permit <br /> BASEMENT: 1ST FLOOR: <br /> - (/4 + TOTAL SQUARE FOOTAGE: + (slopes,disturbance, Q <br /> I/ r / <br /> 2ND FLOOR: 3RD FLOOR: I Air /i <br /> a Review Location Survey , -/' <br /> ESTIMATED CONSTRUCTION COST: ♦ ♦ ♦ ♦ ♦ $ �� and available options. /tom <br /> (Please round to nearest dollar) , <br /> 1. The property is within 300 feet of a stream or 1000 feet from a pond or lake? ❑Yes jaio ❑Don't know <br /> 2. Is there a wetland or floodplain on or near the property? ❑Yes o ❑Don't know <br /> 3. Have you talked with the township about your project and are they in agreement? YesVo <br /> 4. Has there been a zoning permit issued for this property in the past 5 years? DYes ao <br /> 5. Is this project associated with a rezone/CUP/variance(petition/appeal# ) (leave blank if none) <br /> 6. Is a location survey required? (see reverse) ❑Yes RINio ❑Don't know <br /> 7. Is this to correct a violation? ❑Yes Rio <br /> T A LIGATION MUST BE SIGNED <br /> / ( ntinue on Back) -♦ —► —* <br /> 545-112(4/08) <br />